Illustration: Gabriella Turrisi/Axios
The House Education and Workforce Committee is adding to the bipartisan scrutiny of hospitals tomorrow with a markup of legislation that aims to crack down on anti-competitive practices and allow for more flexible contracts.
Why it matters: It's another sign of Congress' willingness to target practices that critics argue are enriching facilities and raising prices for patients.
- Site-neutral payment policies have dominated the discussion of the 118th Congress, though there's growing interest at the committee level in curtailing anti-competitive practices and addressing hospital consolidation.
What's inside: Education and Workforce is considering the Healthy Competition for Better Care Act, from Rep. Michelle Steel (which we reported on first last year) along with legislation addressing certain telehealth facility fees.
- Steel's bill would give insurers and employers more discretion to enter into contracts with the hospitals and providers that they deem make the most sense for patients, without being forced to enter into a contract with all the affiliated facilities in a system.
- The legislation would allow for more flexible contracting arrangements, including having insurers negotiate their own rates with providers who aren't in their network and letting hospitals and insurers negotiate prices without requirements to stick to the prices that other insurers have agreed to.
- The bill does have exceptions for certain group arrangements, including HMOs and value-based networks like ACOs.
- The telehealth facility fee bill from Rep. Aaron Bean would ban facility fees and other payments added for telehealth services in ERISA.
Between the lines: The ERISA Industry Group, which represents employers with benefit plans, told Axios that it supports the contracting bill, noting that businesses "have been concerned for decades about health system consolidation and limited access to certain provider groups."
- The legislation "has the potential to improve fairness in contracting within the health care system," the group said.
The other side: Hospital groups are lined up in opposition.
- The changes will "further empower wealthy commercial insurance companies at the expense of patients," Jason Kleinman, director of federal relations at the American Hospital Association, said in a statement to Axios.
- "At a time when insurers are acquiring physician practices at an alarming rate, this legislation would encourage insurers to steer patients to their own affiliated providers — instead of high-quality coordinated health systems," said Federation of American Hospitals spokesperson Charlene MacDonald.
Flashback: A primary care and health workforce package that the Senate HELP Committee approved last September included a provision that would have banned anti-competitive terms in contracting, as well as language to curb certain hospital facility fees, including for telehealth services.
- That package was developed under the unusual partnership of HELP Chair Bernie Sanders and Sen. Roger Marshall.
- HELP ranking member Bill Cassidy opposed the legislation on the grounds its cost was not completely offset, among other issues. Only two other Republican senators joined Marshall in voting the bill out of committee: Sens. Mike Braun and Lisa Murkowski.
- But the bill could be a potential cost-saver in a bigger health deal: CBO estimated that the contracting and facility fee measures in the package would generate about $5 billion in added revenue over a decade.
What we're watching: Whether there's Democratic support for the bill at Wednesday's Education and Workforce markup. The contracting bill has one Democratic co-sponsor: Rep. Don Davis.
- The committee on Wednesday will also take up a Congressional Review Act resolution disapproving a Biden administration rule issued in April that rescinded former President Trump's expansion of association health plans.
